Multisystem collaboration and actions are needed to tackle childhood obesity, especially in the most vulnerable. This review aimed to describe the regulatory and operational framework associated with four delivery systems (social protection, food, education and health) for obesity prevention in children in need in Greece, and to synthesise related evidence of effectiveness, implementation, barriers and facilitators. The Joanna Briggs Institute (JBI) guidelines for scoping reviews were used, and identified policy interventions were categorised into delivery systems in addition to the Analysis Grid for Environments Linked to Obesity (ANGELO) framework. Peer‐reviewed journal articles and grey literature describing the Greek regulatory and operational framework addressing obesity in children in need (2–18 years old) considering the EU policy environment, were searched. 28 policy interventions were identified, and only one of them referred specifically to children in need. Most interventions were delivered through the health system and in 16 policy interventions nutrition was the targeted behaviour; two policies targeted physical activity, while 10 interventions targeted both nutrition and physical activity. Limited information was identified in terms of policy implementation and effectiveness, and even less for impact. Important barriers for implementation included sociocultural determinants and procurement issues for food provision/assistance policies. In Greece, children in need are an understudied population group, and there is a lack of evidence of enabling environments to tackle obesity. This review provides consolidated evidence of the policy interventions in Greece for the first time, with the likelihood of stimulating further action at the national level and of supporting related discussion at the European level.

Background/Objectives: The prevalence of obesity is high among children living with disability. The present study aimed to examine the perceptions of parents and caregivers of children living with disability regarding children’s energy balance related behaviors (EBRBs) and their determinants. Methods: Parents/caregivers of children living with disability (n = 45) from Thessaly, Crete and Attica Regions of Greece, participated in semi-structured interviews between November and December 2023. The interviews were recorded, transcribed and transferred to N-VIVO software. The results were analyzed according to the framework of the socio-ecological model, using deductive thematic analysis. Results: Parents/caregivers reported that eating habits of children living with disability and their physical activity levels were poorer compared to the general population. At an individual level, certain disabilities may affect children’s food preferences and parents’ ability to prepare healthy foods. At a familial level, financial difficulties may influence healthy eating, whereas some parents/caregivers act as children’s role models to encourage them to be physically active. Home food environments may also influence children’s eating patterns and peer influence on their EBRBs. At a community level, lack of trained personnel, available amenities/equipment and food education initiatives and the availability of unhealthy foods in school canteens were described as major barriers to healthy EBRBs. At an organizational level, lack of accessible/safe facilities, the marginalization/stigma that children living with disability may experience and lack of dietitians/nutritionists in health centers were named as the main factors influencing children’s EBRBs. Conclusions: The findings of this study highlight the importance of designing multi-sectoral policy interventions to promote healthy EBRBs and tackle obesity in children living with disability in Greece.

Background/Objectives: Policy implementers play a crucial role in the effective delivery of policies aiming at promoting a healthy lifestyle in the most vulnerable populations. This study aimed to explore (a) policy implementers’ knowledge and perceptions of the policy framework promoting physical activity and healthy nutrition among children in need in Greece, and (b) self-perceived barriers and facilitators of the framework implementation. The term children in need refers to children who are at risk of poverty and/or social exclusion. Methods: A qualitative study design was employed consisting of semi-structured interviews with 25 policy implementers, who represented four delivery systems (health, social protection, food, and education sectors) from three geographical regions in Greece. Interviews were completed between November and December 2023. Thematic analysis was conducted using inductive and deductive approaches to identify key themes, following data management in the N-VIVO 14 software. Results: Commonly mentioned policies that study participants were involved in included school- and/or community-level-based behavioral interventions. Participants perceived policy implementation efforts that often relied on individual initiatives as inconsistent. Most participants argued that existing policies were not tailored to the needs of children in need. Major self-perceived barriers included limited personnel training, limited facilities and infrastructure, and lack of incentives or opportunities to encourage active participation. Major self-perceived facilitators included personnel motivation, integration of nutrition and physical education into school curricula, and provision of free school meals, which was associated with regular school attendance of children from the Roma communities. Conclusions: Individual, sociocultural, and structural issues are shown to persist across different delivery systems indicating the complexity of tackling obesogenic environments, especially among children in need. This is the first study in Greece to provide evidence on self-perceived barriers and facilitators and could inform ongoing national and European efforts to address obesogenic environments in children in need.

Background/Objectives: Childhood obesity remains a critical public health concern in Greece, particularly among socioeconomically vulnerable groups. This study conducted a secondary analysis of five large-scale epidemiological datasets to examine the association between energy balance-related behaviours (EBRBs) and obesity in children in need. Methods: Data were compiled from five nationally or regionally representative studies (Genesis, ToyBox, Healthy Growth, ENERGY, and Feel4Diabetes) involving children aged 1–12 years. Stratified and subgroup analyses were performed to examine associations between weight status and EBRBs, including dietary habits, physical activity, and sedentary behaviour. Determinants of EBRBs were also analysed using the socio-ecological model framework. Results: Children in need demonstrated a higher prevalence of overweight and obesity compared to the general child population. Key risk factors for EBRBs included frequent consumption of sugar-sweetened beverages, sweet snacks, and high screen time. Protective behaviours associated with lower obesity risk included regular breakfast consumption, adequate sleep duration, and physical activity. Determinants of high-risk EBRBs were primarily interpersonal and, to a lesser extent, individual and community-level factors. Conclusions: These findings highlight the disproportionate burden of childhood obesity among vulnerable populations and identify modifiable behaviours and determinants that can inform targeted interventions. These results provide a robust evidence base to guide national public health policies, including the development of school- and community-based obesity prevention programmes aligned with the goals of Greece’s National Action Against Childhood Obesity. Prioritising children in need in such initiatives is essential to reduce health inequities and improve long-term health outcomes.

Background/Objectives: Social vulnerability is linked to unhealthy eating habits, low physical activity, and, overall, increased health risks and low well-being. This study examined self-perceived barriers and facilitators to engaging in obesity prevention policies for children at risk of poverty and social exclusion in Greece from the perspective of parents, caregivers, and community representatives. Methods: A qualitative study was conducted from November to December 2023 in three geographically diverse Greek regions, namely Attica, Thessaly, and Crete. A qualitative study was conducted between November and December 2023 in three geographically diverse regions of Greece. In total, seventy-two individuals participated in the study through individual interviews and focus groups. Forty-five parents of children with disabilities took part in individual interviews, equally represented in all three regions (fifteen participants per region). Among focus group participants: Twenty-one caregivers from child protection units participated in six focus groups (two per region), with focus group sizes ranging from three to five participants. In addition, six Roma community representatives participated in three focus groups (one per region), with focus group sizes ranging from one to four participants. Inductive and deductive thematic analysis were performed using NVivo 14 software to identify key themes. Results: Most factors that increased engagement were perceived by participants as both barriers and facilitators. These factors were classified at the individual, sociocultural, or structural level, and similar themes emerged across groups. Common barriers to poor engagement included low health literacy, financial difficulties and underfunding, social exclusion, a lack of targeted nutrition interventions, concerns related to training opportunities and support, and the adequacy and safety of built environments. Common facilitators of enhanced engagement included increased awareness and motivation to support vulnerable children, the availability of community- and school-based initiatives, and free school meal provision. Conclusions: Engagement in obesity prevention policies targeting vulnerable children is influenced by multiple interrelated factors. Understanding these barriers and facilitators from the participants’ perspectives can guide policymakers and practitioners in designing more effective obesity-related interventions for socially vulnerable groups of children.